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Maryland rates for HCPCS J0133

Injection, acyclovir, 5 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $33.88 / $218.78
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.10 / $0.12 / $0.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.04 / $0.12 / $0.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.05 / $0.05 / $0.05